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Submission: On April 06 via api from US — Scanned from DE
Submission: On April 06 via api from US — Scanned from DE
Form analysis 1 forms found in the DOM
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<form method="post" action="https://www.tfaforms.com/api_v2/workflow/processor" class="hintsTooltip labelsAbove" id="4884070" role="form">
<div class="saveAndResume">
<div class="oneField">
<span class="oneChoice"><input type="checkbox" id="tfa_saveForLater" name="tfa_saveForLater" value="1" data-conditionals="#saveAndResumeFieldset" autocomplete="off"><label for="tfa_saveForLater" class="postField">Save my progress and resume
later</label></span> |
<a href="https://www.tfaforms.com/forms/resume/4884070" onclick="return confirm('Are you sure you want to resume a previous response? Any information you just entered on this page will be discarded.');">Resume a previously saved form</a>
</div>
</div>
<div class="saveAndResume offstate" id="saveAndResumeFieldset" data-condition="`#tfa_saveForLater`">
<fieldset>
<legend>Resume Later</legend>
<p class="instructions">In order to be able to resume this form later, please enter your email and choose a password.</p>
<div class="oneField">
<label class="preField" for="tfa_resumeEmail">Your Email:</label><input type="text" value="" name="tfa_resumeEmail" id="tfa_resumeEmail" disabled="">
</div>
<div class="oneField">
<label class="preField" for="tfa_resumePassword">A Password:</label><input type="password" value="" name="tfa_resumePassword" id="tfa_resumePassword" disabled="">
</div>
<div class="oneField">
<label class="preField" for="tfa_confirmPassword">Confirm Password:</label><input type="password" value="" name="tfa_confirmPassword" id="tfa_confirmPassword" disabled="">
</div>
<div class="actions">
<script type="text/javascript">
wFORMS.behaviors.validation.passwordStrength = "medium";
</script><input type="button" class="primaryAction" id="tfa_resumeLater" name="tfa_resumeLater" value="Save" disabled="">
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</div>
<fieldset id="tfa_SurveyOverview" class="section">
<legend id="tfa_SurveyOverview-L">Survey Overview</legend>
<div class="htmlSection" id="tfa_7785203260745">
<div class="htmlContent" id="tfa_7785203260745-HTML">
<p style="margin-bottom:0in;margin-bottom:.0001pt;line-height:
normal" class="MsoNormal"><span style="font-size:12.0pt;font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";color:#323333">This site survey questionnaire is used to request network information to configure your <i>SimNow Skills Simulator</i></span><sup><span style="font-size:9.0pt;
font-family:"Times New Roman",serif;mso-fareast-font-family:"Times New Roman";
color:#323333">™1</span></sup><span style="font-size:12.0pt;font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";color:#323333">for the <i>da
Vinci</i></span><sub><span style="font-size:9.0pt;font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";color:#323333">®</span></sub><span style="font-size:12.0pt;font-family:"Times New Roman",serif;mso-fareast-font-family:
"Times New Roman";color:#323333"> Surgical System. The requested network information that you provide will be used by Intuitive Surgical personnel to configure the <i>SimNow Skills Simulator </i>for use on the network.</span></p>
<p style="margin-bottom:0in;margin-bottom:.0001pt;line-height:
normal" class="MsoNormal"><br></p>
<p>
</p>
<p style="margin-bottom:0in;margin-bottom:.0001pt;line-height:
normal" class="MsoNormal"><span style="font-size:12.0pt;font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";color:#323333">For any questions regarding this survey please contact the Intuitive Surgical Product Networking and Data Team at 1(800) 876-1310 opt 2,2 or email </span><a href="mailto:PND@intusurg.com"><span style="font-size:12.0pt;font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman"">PND@intusurg.com</span></a><span style="font-size:12.0pt;font-family:"Times New Roman",serif;mso-fareast-font-family:
"Times New Roman";color:#323333">.</span></p>
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<legend id="tfa_2066578511462-L">Hospital / System Information</legend>
<div class="oneField field-container-D " id="tfa_HospitalOrganiza-D">
<label id="tfa_HospitalOrganiza-L" class="label preField reqMark" for="tfa_HospitalOrganiza">Hospital / Organization:</label><br>
<div class="inputWrapper"><input aria-required="true" type="text" id="tfa_HospitalOrganiza" name="tfa_HospitalOrganiza" value="" title="Hospital / Organization:" class="required"></div>
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<div class="oneField field-container-D " id="tfa_FirstName-D">
<label id="tfa_FirstName-L" class="label preField reqMark" for="tfa_FirstName">Customer / Contact:</label><br>
<div class="inputWrapper"><input aria-required="true" type="text" id="tfa_FirstName" name="tfa_FirstName" value="" title="Customer / Contact:" class="required"></div>
</div>
<div class="oneField field-container-D " id="tfa_Title-D">
<label id="tfa_Title-L" class="label preField " for="tfa_Title">Title:</label><br>
<div class="inputWrapper"><input type="text" id="tfa_Title" name="tfa_Title" value="" title="Title:" class=""></div>
</div>
<div class="oneField field-container-D " id="tfa_Phone-D">
<label id="tfa_Phone-L" class="label preField reqMark" for="tfa_Phone">Phone #:</label><br>
<div class="inputWrapper"><input aria-required="true" type="text" id="tfa_Phone" name="tfa_Phone" value="" title="Phone #:" class="validate-phone required"></div>
</div>
<div class="oneField field-container-D " id="tfa_ContacteMailAddr-D">
<label id="tfa_ContacteMailAddr-L" class="label preField reqMark" for="tfa_ContacteMailAddr">Contact eMail:</label><br>
<div class="inputWrapper"><input aria-required="true" type="text" id="tfa_ContacteMailAddr" name="tfa_ContacteMailAddr" value="" title="Contact eMail:" class="validate-email required"></div>
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<div class="oneField field-container-D " id="tfa_Address-D">
<label id="tfa_Address-L" class="label preField " for="tfa_Address">Address 1:</label><br>
<div class="inputWrapper"><input type="text" id="tfa_Address" name="tfa_Address" value="" title="Address 1:" class=""></div>
</div>
<div class="oneField field-container-D " id="tfa_Address2-D">
<label id="tfa_Address2-L" class="label preField " for="tfa_Address2">Address 2:</label><br>
<div class="inputWrapper"><input type="text" id="tfa_Address2" name="tfa_Address2" value="" title="Address 2:" class=""></div>
</div>
<div class="oneField field-container-D " id="tfa_City-D">
<label id="tfa_City-L" class="label preField " for="tfa_City">City:</label><br>
<div class="inputWrapper"><input type="text" id="tfa_City" name="tfa_City" value="" title="City:" class=""></div>
</div>
<div class="oneField field-container-D " id="tfa_3459046471499-D">
<label id="tfa_3459046471499-L" class="label preField " for="tfa_3459046471499">Zip/Postal Code:</label><br>
<div class="inputWrapper"><input type="text" id="tfa_3459046471499" name="tfa_3459046471499" value="" title="Zip/Postal Code:" class=""></div>
</div>
<div class="oneField field-container-D " id="tfa_Country1-D">
<label id="tfa_Country1-L" class="label preField " for="tfa_Country1">Country:</label><br>
<div class="inputWrapper"><select id="tfa_Country1" name="tfa_Country1" title="Country:" class="">
<option value="">Please select...</option>
<option value="AF" id="AF" class="">Afghanistan</option>
<option value="tfa_Albania1" id="tfa_Albania1" class="">Albania</option>
<option value="tfa_Algeria1" id="tfa_Algeria1" class="">Algeria</option>
<option value="tfa_AmericanSamoa2" id="tfa_AmericanSamoa2" class="">American Samoa</option>
<option value="tfa_Andorra1" id="tfa_Andorra1" class="">Andorra</option>
<option value="tfa_Angola1" id="tfa_Angola1" class="">Angola</option>
<option value="tfa_Anguilla1" id="tfa_Anguilla1" class="">Anguilla</option>
<option value="tfa_Antarctica1" id="tfa_Antarctica1" class="">Antarctica</option>
<option value="tfa_Antigua" id="tfa_Antigua" class="">Antigua </option>
<option value="tfa_Argentina1" id="tfa_Argentina1" class="">Argentina</option>
<option value="tfa_Armenia1" id="tfa_Armenia1" class="">Armenia</option>
<option value="tfa_Aruba1" id="tfa_Aruba1" class="">Aruba</option>
<option value="tfa_Australia1" id="tfa_Australia1" class="">Australia</option>
<option value="tfa_Austria1" id="tfa_Austria1" class="">Austria</option>
<option value="tfa_Azerbaijan1" id="tfa_Azerbaijan1" class="">Azerbaijan</option>
<option value="tfa_Bahamas1" id="tfa_Bahamas1" class="">Bahamas</option>
<option value="tfa_Bahrain1" id="tfa_Bahrain1" class="">Bahrain</option>
<option value="tfa_Bangladesh1" id="tfa_Bangladesh1" class="">Bangladesh</option>
<option value="tfa_Barbados1" id="tfa_Barbados1" class="">Barbados</option>
<option value="tfa_Belarus1" id="tfa_Belarus1" class="">Belarus</option>
<option value="tfa_Belgium1" id="tfa_Belgium1" class="">Belgium</option>
<option value="tfa_Belize1" id="tfa_Belize1" class="">Belize</option>
<option value="tfa_Benin1" id="tfa_Benin1" class="">Benin</option>
<option value="tfa_Bermuda1" id="tfa_Bermuda1" class="">Bermuda</option>
<option value="tfa_Bhutan1" id="tfa_Bhutan1" class="">Bhutan</option>
<option value="tfa_Bolivia1" id="tfa_Bolivia1" class="">Bolivia</option>
<option value="tfa_Bosnia" id="tfa_Bosnia" class="">Bosnia </option>
<option value="tfa_Botswana1" id="tfa_Botswana1" class="">Botswana</option>
<option value="tfa_BouvetIsland1" id="tfa_BouvetIsland1" class="">Bouvet Island</option>
<option value="tfa_Brazil1" id="tfa_Brazil1" class="">Brazil</option>
<option value="tfa_Brunei1" id="tfa_Brunei1" class="">Brunei</option>
<option value="tfa_Bulgaria1" id="tfa_Bulgaria1" class="">Bulgaria</option>
<option value="tfa_BurkinaFaso1" id="tfa_BurkinaFaso1" class="">Burkina Faso</option>
<option value="tfa_Burundi1" id="tfa_Burundi1" class="">Burundi</option>
<option value="tfa_Cambodia1" id="tfa_Cambodia1" class="">Cambodia</option>
<option value="tfa_Cameroon1" id="tfa_Cameroon1" class="">Cameroon</option>
<option value="tfa_Canada1" id="tfa_Canada1" class="">Canada</option>
<option value="tfa_CapeVerde1" id="tfa_CapeVerde1" class="">Cape Verde</option>
<option value="tfa_CaymanIslands1" id="tfa_CaymanIslands1" class="">Cayman Islands</option>
<option value="tfa_CentralAfricanRe1" id="tfa_CentralAfricanRe1" class="">Central African Republic</option>
<option value="tfa_Chad1" id="tfa_Chad1" class="">Chad</option>
<option value="tfa_Chile1" id="tfa_Chile1" class="">Chile</option>
<option value="tfa_China1" id="tfa_China1" class="">China</option>
<option value="tfa_ChristmasIsland1" id="tfa_ChristmasIsland1" class="">Christmas Island</option>
<option value="tfa_CocosKeelingIsla1" id="tfa_CocosKeelingIsla1" class="">Cocos ( Keeling ) Islands</option>
<option value="tfa_Colombia1" id="tfa_Colombia1" class="">Colombia</option>
<option value="tfa_Comoros1" id="tfa_Comoros1" class="">Comoros</option>
<option value="tfa_Congo1" id="tfa_Congo1" class="">Congo</option>
<option value="tfa_CookIslands1" id="tfa_CookIslands1" class="">Cook Islands</option>
<option value="tfa_CostaRica1" id="tfa_CostaRica1" class="">Costa Rica</option>
<option value="tfa_CtedIvoire1" id="tfa_CtedIvoire1" class="">Côte d ' Ivoire</option>
<option value="tfa_CroatiaHrvatska1" id="tfa_CroatiaHrvatska1" class="">Croatia ( Hrvatska )</option>
<option value="tfa_Cuba1" id="tfa_Cuba1" class="">Cuba</option>
<option value="tfa_Cyprus1" id="tfa_Cyprus1" class="">Cyprus</option>
<option value="tfa_CzechRepublic1" id="tfa_CzechRepublic1" class="">Czech Republic</option>
<option value="tfa_CongoDRC1" id="tfa_CongoDRC1" class="">Congo ( DRC )</option>
<option value="tfa_Denmark1" id="tfa_Denmark1" class="">Denmark</option>
<option value="tfa_Djibouti1" id="tfa_Djibouti1" class="">Djibouti</option>
<option value="tfa_Dominica1" id="tfa_Dominica1" class="">Dominica</option>
<option value="tfa_DominicanRepubli1" id="tfa_DominicanRepubli1" class="">Dominican Republic</option>
<option value="tfa_EastTimor1" id="tfa_EastTimor1" class="">East Timor</option>
<option value="tfa_Ecuador1" id="tfa_Ecuador1" class="">Ecuador</option>
<option value="tfa_Egypt1" id="tfa_Egypt1" class="">Egypt</option>
<option value="tfa_ElSalvador1" id="tfa_ElSalvador1" class="">El Salvador</option>
<option value="tfa_EquatorialGuinea1" id="tfa_EquatorialGuinea1" class="">Equatorial Guinea</option>
<option value="tfa_Eritrea1" id="tfa_Eritrea1" class="">Eritrea</option>
<option value="tfa_Estonia1" id="tfa_Estonia1" class="">Estonia</option>
<option value="tfa_Ethiopia1" id="tfa_Ethiopia1" class="">Ethiopia</option>
<option value="tfa_FaroeIslands1" id="tfa_FaroeIslands1" class="">Faroe Islands</option>
<option value="tfa_FijiIslands1" id="tfa_FijiIslands1" class="">Fiji Islands</option>
<option value="tfa_Finland1" id="tfa_Finland1" class="">Finland</option>
<option value="tfa_France1" id="tfa_France1" class="">France</option>
<option value="tfa_FrenchGuiana1" id="tfa_FrenchGuiana1" class="">French Guiana</option>
<option value="tfa_FrenchPolynesia1" id="tfa_FrenchPolynesia1" class="">French Polynesia</option>
<option value="tfa_Gabon1" id="tfa_Gabon1" class="">Gabon</option>
<option value="tfa_Gambia1" id="tfa_Gambia1" class="">Gambia</option>
<option value="tfa_Georgia2" id="tfa_Georgia2" class="">Georgia</option>
<option value="tfa_Germany1" id="tfa_Germany1" class="">Germany</option>
<option value="tfa_Ghana1" id="tfa_Ghana1" class="">Ghana</option>
<option value="tfa_Gibraltar1" id="tfa_Gibraltar1" class="">Gibraltar</option>
<option value="tfa_Greece1" id="tfa_Greece1" class="">Greece</option>
<option value="tfa_Greenland1" id="tfa_Greenland1" class="">Greenland</option>
<option value="tfa_Grenada1" id="tfa_Grenada1" class="">Grenada</option>
<option value="tfa_Guadeloupe1" id="tfa_Guadeloupe1" class="">Guadeloupe</option>
<option value="tfa_Guam2" id="tfa_Guam2" class="">Guam</option>
<option value="tfa_Guatemala1" id="tfa_Guatemala1" class="">Guatemala</option>
<option value="tfa_Guinea1" id="tfa_Guinea1" class="">Guinea</option>
<option value="tfa_GuineaBissau1" id="tfa_GuineaBissau1" class="">Guinea-Bissau</option>
<option value="tfa_Guyana1" id="tfa_Guyana1" class="">Guyana</option>
<option value="tfa_Haiti1" id="tfa_Haiti1" class="">Haiti</option>
<option value="tfa_Honduras1" id="tfa_Honduras1" class="">Honduras</option>
<option value="tfa_HongKongSAR1" id="tfa_HongKongSAR1" class="">Hong Kong SAR</option>
<option value="tfa_Hungary1" id="tfa_Hungary1" class="">Hungary</option>
<option value="tfa_Iceland1" id="tfa_Iceland1" class="">Iceland</option>
<option value="tfa_India1" id="tfa_India1" class="">India</option>
<option value="tfa_Indonesia1" id="tfa_Indonesia1" class="">Indonesia</option>
<option value="tfa_Iran1" id="tfa_Iran1" class="">Iran</option>
<option value="tfa_Iraq1" id="tfa_Iraq1" class="">Iraq</option>
<option value="tfa_Ireland1" id="tfa_Ireland1" class="">Ireland</option>
<option value="tfa_Israel1" id="tfa_Israel1" class="">Israel</option>
<option value="tfa_Italy1" id="tfa_Italy1" class="">Italy</option>
<option value="tfa_Jamaica1" id="tfa_Jamaica1" class="">Jamaica</option>
<option value="tfa_Japan1" id="tfa_Japan1" class="">Japan</option>
<option value="tfa_Jordan1" id="tfa_Jordan1" class="">Jordan</option>
<option value="tfa_Kazakhstan1" id="tfa_Kazakhstan1" class="">Kazakhstan</option>
<option value="tfa_Kenya1" id="tfa_Kenya1" class="">Kenya</option>
<option value="tfa_Kiribati1" id="tfa_Kiribati1" class="">Kiribati</option>
<option value="tfa_Korea1" id="tfa_Korea1" class="">Korea</option>
<option value="tfa_Kuwait1" id="tfa_Kuwait1" class="">Kuwait</option>
<option value="tfa_Kyrgyzstan1" id="tfa_Kyrgyzstan1" class="">Kyrgyzstan</option>
<option value="tfa_Laos1" id="tfa_Laos1" class="">Laos</option>
<option value="tfa_Latvia1" id="tfa_Latvia1" class="">Latvia</option>
<option value="tfa_Lebanon1" id="tfa_Lebanon1" class="">Lebanon</option>
<option value="tfa_Lesotho1" id="tfa_Lesotho1" class="">Lesotho</option>
<option value="tfa_Liberia1" id="tfa_Liberia1" class="">Liberia</option>
<option value="tfa_Libya1" id="tfa_Libya1" class="">Libya</option>
<option value="tfa_Liechtenstein1" id="tfa_Liechtenstein1" class="">Liechtenstein</option>
<option value="tfa_Lithuania1" id="tfa_Lithuania1" class="">Lithuania</option>
<option value="tfa_Luxembourg1" id="tfa_Luxembourg1" class="">Luxembourg</option>
<option value="tfa_MacaoSAR1" id="tfa_MacaoSAR1" class="">Macao SAR</option>
<option value="tfa_Macedonia" id="tfa_Macedonia" class="">Macedonia</option>
<option value="tfa_Madagascar1" id="tfa_Madagascar1" class="">Madagascar</option>
<option value="tfa_Malawi1" id="tfa_Malawi1" class="">Malawi</option>
<option value="tfa_Malaysia1" id="tfa_Malaysia1" class="">Malaysia</option>
<option value="tfa_Maldives1" id="tfa_Maldives1" class="">Maldives</option>
<option value="tfa_Mali1" id="tfa_Mali1" class="">Mali</option>
<option value="tfa_Malta1" id="tfa_Malta1" class="">Malta</option>
<option value="tfa_MarshallIslands1" id="tfa_MarshallIslands1" class="">Marshall Islands</option>
<option value="tfa_Martinique1" id="tfa_Martinique1" class="">Martinique</option>
<option value="tfa_Mauritania1" id="tfa_Mauritania1" class="">Mauritania</option>
<option value="tfa_Mauritius1" id="tfa_Mauritius1" class="">Mauritius</option>
<option value="tfa_Mayotte1" id="tfa_Mayotte1" class="">Mayotte</option>
<option value="tfa_Mexico1" id="tfa_Mexico1" class="">Mexico</option>
<option value="tfa_Micronesia1" id="tfa_Micronesia1" class="">Micronesia</option>
<option value="tfa_Moldova1" id="tfa_Moldova1" class="">Moldova</option>
<option value="tfa_Monaco1" id="tfa_Monaco1" class="">Monaco</option>
<option value="tfa_Mongolia1" id="tfa_Mongolia1" class="">Mongolia</option>
<option value="tfa_Montserrat1" id="tfa_Montserrat1" class="">Montserrat</option>
<option value="tfa_Morocco1" id="tfa_Morocco1" class="">Morocco</option>
<option value="tfa_Mozambique1" id="tfa_Mozambique1" class="">Mozambique</option>
<option value="tfa_Myanmar1" id="tfa_Myanmar1" class="">Myanmar</option>
<option value="tfa_Namibia1" id="tfa_Namibia1" class="">Namibia</option>
<option value="tfa_Nauru1" id="tfa_Nauru1" class="">Nauru</option>
<option value="tfa_Nepal1" id="tfa_Nepal1" class="">Nepal</option>
<option value="tfa_Netherlands1" id="tfa_Netherlands1" class="">Netherlands</option>
<option value="tfa_NetherlandsAntil1" id="tfa_NetherlandsAntil1" class="">Netherlands Antilles</option>
<option value="tfa_NewCaledonia1" id="tfa_NewCaledonia1" class="">New Caledonia</option>
<option value="tfa_NewZealand1" id="tfa_NewZealand1" class="">New Zealand</option>
<option value="tfa_Nicaragua1" id="tfa_Nicaragua1" class="">Nicaragua</option>
<option value="tfa_Niger1" id="tfa_Niger1" class="">Niger</option>
<option value="tfa_Nigeria1" id="tfa_Nigeria1" class="">Nigeria</option>
<option value="tfa_Niue1" id="tfa_Niue1" class="">Niue</option>
<option value="tfa_NorfolkIsland1" id="tfa_NorfolkIsland1" class="">Norfolk Island</option>
<option value="tfa_NorthKorea1" id="tfa_NorthKorea1" class="">North Korea</option>
<option value="tfa_NorthernMarianaI2" id="tfa_NorthernMarianaI2" class="">Northern Mariana Islands</option>
<option value="tfa_Norway1" id="tfa_Norway1" class="">Norway</option>
<option value="tfa_Oman1" id="tfa_Oman1" class="">Oman</option>
<option value="tfa_Pakistan1" id="tfa_Pakistan1" class="">Pakistan</option>
<option value="tfa_Palau2" id="tfa_Palau2" class="">Palau</option>
<option value="tfa_Panama1" id="tfa_Panama1" class="">Panama</option>
<option value="tfa_PapuaNewGuinea1" id="tfa_PapuaNewGuinea1" class="">Papua New Guinea</option>
<option value="tfa_Paraguay1" id="tfa_Paraguay1" class="">Paraguay</option>
<option value="tfa_Peru1" id="tfa_Peru1" class="">Peru</option>
<option value="tfa_Philippines1" id="tfa_Philippines1" class="">Philippines</option>
<option value="tfa_PitcairnIslands1" id="tfa_PitcairnIslands1" class="">Pitcairn Islands</option>
<option value="tfa_Poland1" id="tfa_Poland1" class="">Poland</option>
<option value="tfa_Portugal1" id="tfa_Portugal1" class="">Portugal</option>
<option value="tfa_PuertoRico2" id="tfa_PuertoRico2" class="">Puerto Rico</option>
<option value="tfa_Qatar1" id="tfa_Qatar1" class="">Qatar</option>
<option value="tfa_Reunion1" id="tfa_Reunion1" class="">Reunion</option>
<option value="tfa_Romania1" id="tfa_Romania1" class="">Romania</option>
<option value="tfa_Russia1" id="tfa_Russia1" class="">Russia</option>
<option value="tfa_Rwanda1" id="tfa_Rwanda1" class="">Rwanda</option>
<option value="tfa_Samoa1" id="tfa_Samoa1" class="">Samoa</option>
<option value="tfa_SanMarino1" id="tfa_SanMarino1" class="">San Marino</option>
<option value="tfa_SoTomandPrncipe1" id="tfa_SoTomandPrncipe1" class="">São Tomé and Prìncipe</option>
<option value="tfa_SaudiArabia1" id="tfa_SaudiArabia1" class="">Saudi Arabia</option>
<option value="tfa_Senegal1" id="tfa_Senegal1" class="">Senegal</option>
<option value="tfa_SerbiaandMontene1" id="tfa_SerbiaandMontene1" class="">Serbia and Montenegro</option>
<option value="tfa_Seychelles1" id="tfa_Seychelles1" class="">Seychelles</option>
<option value="tfa_SierraLeone1" id="tfa_SierraLeone1" class="">Sierra Leone</option>
<option value="tfa_Singapore1" id="tfa_Singapore1" class="">Singapore</option>
<option value="tfa_Slovakia1" id="tfa_Slovakia1" class="">Slovakia</option>
<option value="tfa_Slovenia1" id="tfa_Slovenia1" class="">Slovenia</option>
<option value="tfa_SolomonIslands1" id="tfa_SolomonIslands1" class="">Solomon Islands</option>
<option value="tfa_Somalia1" id="tfa_Somalia1" class="">Somalia</option>
<option value="tfa_SouthAfrica1" id="tfa_SouthAfrica1" class="">South Africa</option>
<option value="tfa_SGeorgiaSSandwic" id="tfa_SGeorgiaSSandwic" class="">S Georgia & S Sandwich Islands</option>
<option value="tfa_Spain1" id="tfa_Spain1" class="">Spain</option>
<option value="tfa_SriLanka1" id="tfa_SriLanka1" class="">Sri Lanka</option>
<option value="tfa_StHelena1" id="tfa_StHelena1" class="">St. Helena</option>
<option value="tfa_StKittsandNevis1" id="tfa_StKittsandNevis1" class="">St. Kitts and Nevis</option>
<option value="tfa_StLucia1" id="tfa_StLucia1" class="">St. Lucia</option>
<option value="tfa_StPierreandMique1" id="tfa_StPierreandMique1" class="">St. Pierre and Miquelon</option>
<option value="tfa_StVincentandtheG1" id="tfa_StVincentandtheG1" class="">St. Vincent and the Grenadines</option>
<option value="tfa_Sudan1" id="tfa_Sudan1" class="">Sudan</option>
<option value="tfa_Suriname1" id="tfa_Suriname1" class="">Suriname</option>
<option value="tfa_SvalbardandJanMa1" id="tfa_SvalbardandJanMa1" class="">Svalbard and Jan Mayen</option>
<option value="tfa_Swaziland1" id="tfa_Swaziland1" class="">Swaziland</option>
<option value="tfa_Sweden1" id="tfa_Sweden1" class="">Sweden</option>
<option value="tfa_Switzerland1" id="tfa_Switzerland1" class="">Switzerland</option>
<option value="tfa_Syria1" id="tfa_Syria1" class="">Syria</option>
<option value="tfa_Taiwan1" id="tfa_Taiwan1" class="">Taiwan</option>
<option value="tfa_Tajikistan1" id="tfa_Tajikistan1" class="">Tajikistan</option>
<option value="tfa_Tanzania1" id="tfa_Tanzania1" class="">Tanzania</option>
<option value="tfa_Thailand1" id="tfa_Thailand1" class="">Thailand</option>
<option value="tfa_Togo1" id="tfa_Togo1" class="">Togo</option>
<option value="tfa_Tokelau1" id="tfa_Tokelau1" class="">Tokelau</option>
<option value="tfa_Tonga1" id="tfa_Tonga1" class="">Tonga</option>
<option value="tfa_TrinidadandTobag1" id="tfa_TrinidadandTobag1" class="">Trinidad and Tobago</option>
<option value="tfa_Tunisia1" id="tfa_Tunisia1" class="">Tunisia</option>
<option value="tfa_Turkey1" id="tfa_Turkey1" class="">Turkey</option>
<option value="tfa_Turkmenistan1" id="tfa_Turkmenistan1" class="">Turkmenistan</option>
<option value="tfa_TurksandCaicosIs1" id="tfa_TurksandCaicosIs1" class="">Turks and Caicos Islands</option>
<option value="tfa_Tuvalu1" id="tfa_Tuvalu1" class="">Tuvalu</option>
<option value="tfa_Uganda1" id="tfa_Uganda1" class="">Uganda</option>
<option value="tfa_Ukraine1" id="tfa_Ukraine1" class="">Ukraine</option>
<option value="tfa_UnitedArabEmirat1" id="tfa_UnitedArabEmirat1" class="">United Arab Emirates</option>
<option value="tfa_UnitedKingdom1" id="tfa_UnitedKingdom1" class="">United Kingdom</option>
<option value="tfa_UnitedStates1" id="tfa_UnitedStates1" class="">United States</option>
<option value="tfa_Uruguay1" id="tfa_Uruguay1" class="">Uruguay</option>
<option value="tfa_Uzbekistan1" id="tfa_Uzbekistan1" class="">Uzbekistan</option>
<option value="tfa_Vanuatu1" id="tfa_Vanuatu1" class="">Vanuatu</option>
<option value="tfa_VaticanCity1" id="tfa_VaticanCity1" class="">Vatican City</option>
<option value="tfa_Venezuela1" id="tfa_Venezuela1" class="">Venezuela</option>
<option value="tfa_VietNam1" id="tfa_VietNam1" class="">Viet Nam</option>
<option value="tfa_VirginIslands1" id="tfa_VirginIslands1" class="">Virgin Islands</option>
<option value="tfa_WallisandFutuna1" id="tfa_WallisandFutuna1" class="">Wallis and Futuna</option>
<option value="tfa_Yemen1" id="tfa_Yemen1" class="">Yemen</option>
<option value="tfa_Zambia1" id="tfa_Zambia1" class="">Zambia</option>
<option value="tfa_Zimbabwe1" id="tfa_Zimbabwe1" class="">Zimbabwe</option>
</select></div>
</div>
<div class="oneField field-container-D " id="tfa_Systemifavailabl-D">
<label id="tfa_Systemifavailabl-L" class="label preField " for="tfa_Systemifavailabl">ID Number(s) or TRK ID(s) (Can be located on the label on the back side of the Skills Simulator, starting with P177...)</label><br>
<div class="inputWrapper"><input type="text" id="tfa_Systemifavailabl" name="tfa_Systemifavailabl" value="" title="ID Number(s) or TRK ID(s) (Can be located on the label on the back side of the Skills Simulator, starting with P177...)"
class=""></div>
</div>
<div class="oneField field-container-D " id="tfa_3459046011023-D">
<label id="tfa_3459046011023-L" class="label preField " for="tfa_3459046011023">Skills Simulator Location:</label><br>
<div class="inputWrapper"><input type="text" id="tfa_3459046011023" name="tfa_3459046011023" value="" title="Skills Simulator Location:" class=""></div>
</div>
<div class="oneField field-container-D " id="tfa_Message-D">
<label id="tfa_Message-L" class="label preField " for="tfa_Message">Message:</label><br>
<div class="inputWrapper"><textarea cols="40" rows="15" id="tfa_Message" name="tfa_Message" title="Message:" class=""></textarea></div>
</div>
</fieldset>
<fieldset id="tfa_ITContacts" class="section">
<legend id="tfa_ITContacts-L">IT Contacts</legend>
<div class="htmlSection" id="tfa_7785203260746">
<div class="htmlContent" id="tfa_7785203260746-HTML">
<p>Please fill out IT contact information. The primary IT contact will be considered by Intuitive Surgical to be the customer's network point of contact.</p>
</div>
</div>
<fieldset id="tfa_ITPrimaryContact4" class="section">
<legend id="tfa_ITPrimaryContact4-L">IT Primary Contact</legend>
<div class="oneField field-container-D " id="tfa_ITPrimaryContact-D">
<label id="tfa_ITPrimaryContact-L" class="label preField reqMark" for="tfa_ITPrimaryContact">IT Primary Contact Name:</label><br>
<div class="inputWrapper"><input aria-required="true" type="text" id="tfa_ITPrimaryContact" name="tfa_ITPrimaryContact" value="" title="IT Primary Contact Name:" class="required"></div>
</div>
<div class="oneField field-container-D " id="tfa_ITPrimaryContact3-D">
<label id="tfa_ITPrimaryContact3-L" class="label preField reqMark" for="tfa_ITPrimaryContact3">IT Primary Contact email:</label><br>
<div class="inputWrapper"><input aria-required="true" type="text" id="tfa_ITPrimaryContact3" name="tfa_ITPrimaryContact3" value="" title="IT Primary Contact email:" class="validate-email required"></div>
</div>
<div class="oneField field-container-D " id="tfa_ITPrimaryContact1-D">
<label id="tfa_ITPrimaryContact1-L" class="label preField reqMark" for="tfa_ITPrimaryContact1">IT Primary Contact Phone:</label><br>
<div class="inputWrapper"><input aria-required="true" type="text" id="tfa_ITPrimaryContact1" name="tfa_ITPrimaryContact1" value="" title="IT Primary Contact Phone:" class="required"></div>
</div>
<div class="oneField field-container-D " id="tfa_ITPrimaryContact2-D">
<label id="tfa_ITPrimaryContact2-L" class="label preField " for="tfa_ITPrimaryContact2">IT Primary Contact Mobile:</label><br>
<div class="inputWrapper"><input type="text" id="tfa_ITPrimaryContact2" name="tfa_ITPrimaryContact2" value="" title="IT Primary Contact Mobile:" class=""></div>
</div>
</fieldset>
<div class="htmlSection" id="tfa_7785203260747">
<div class="htmlContent" id="tfa_7785203260747-HTML"></div>
</div>
<fieldset id="tfa_ITSecondaryConta4" class="section">
<legend id="tfa_ITSecondaryConta4-L">IT Secondary Contact</legend>
<div class="oneField field-container-D " id="tfa_ITSecondaryConta-D">
<label id="tfa_ITSecondaryConta-L" class="label preField " for="tfa_ITSecondaryConta">IT Secondary Contact Name:</label><br>
<div class="inputWrapper"><input type="text" id="tfa_ITSecondaryConta" name="tfa_ITSecondaryConta" value="" title="IT Secondary Contact Name:" class=""></div>
</div>
<div class="oneField field-container-D " id="tfa_ITSecondaryConta3-D">
<label id="tfa_ITSecondaryConta3-L" class="label preField " for="tfa_ITSecondaryConta3">IT Secondary Contact email:</label><br>
<div class="inputWrapper"><input type="text" id="tfa_ITSecondaryConta3" name="tfa_ITSecondaryConta3" value="" title="IT Secondary Contact email:" class="validate-email"></div>
</div>
<div class="oneField field-container-D " id="tfa_ITSecondaryConta1-D">
<label id="tfa_ITSecondaryConta1-L" class="label preField " for="tfa_ITSecondaryConta1">IT Secondary Contact Phone:</label><br>
<div class="inputWrapper"><input type="text" id="tfa_ITSecondaryConta1" name="tfa_ITSecondaryConta1" value="" title="IT Secondary Contact Phone:" class=""></div>
</div>
<div class="oneField field-container-D " id="tfa_ITSecondaryConta2-D">
<label id="tfa_ITSecondaryConta2-L" class="label preField " for="tfa_ITSecondaryConta2">IT Secondary Contact Mobile:</label><br>
<div class="inputWrapper"><input type="text" id="tfa_ITSecondaryConta2" name="tfa_ITSecondaryConta2" value="" title="IT Secondary Contact Mobile:" class=""></div>
</div>
</fieldset>
</fieldset>
<fieldset id="tfa_3541500985268" class="section">
<legend id="tfa_3541500985268-L">SimNow Firewall Requirements</legend>
<div class="htmlSection" id="tfa_7785203260748">
<div class="htmlContent" id="tfa_7785203260748-HTML">
<p style="margin-bottom:0in;margin-bottom:.0001pt;line-height:
normal" class="MsoNormal"><span style="font-size:12.0pt;font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";color:#323333">The <i>da Vinci</i> <i>SimNow </i><i>Skills Simulator</i> requires access to the following URLs on the Internet. The <i>da Vinci Skills Simulator</i> negotiates
an outgoing SSL (TLS) session based on PKI certificate authentication with the Intuitive Surgical cloud server infrastructure to enable simulation content updates, system compatibility firmware updates, operating system patches,
anti-virus definition updates, simulator use metrics, and simulator configurations. The simulator does not store, nor has access to any protected health information. </span></p>
<p style="margin-bottom:0in;margin-bottom:.0001pt;line-height:
normal" class="MsoNormal"><span style="font-size:12.0pt;font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";color:#323333"> </span></p>
<p style="margin-bottom:0in;margin-bottom:.0001pt;line-height:
normal;mso-layout-grid-align:none;text-autospace:none" class="MsoNormal"><br></p>
<table style="border: none;" cellpadding="0" cellspacing="0" border="1" class="MsoTableGrid">
<tbody>
<tr style="mso-yfti-irow:0;mso-yfti-firstrow:yes;height:30.1pt">
<td style="width: 116.85pt; border-width: 1pt; border-style: solid; border-color: windowtext; padding: 0in 5.4pt; height: 30.1pt;" valign="top" width="123">
<p style="margin-bottom:0in;margin-bottom:.0001pt;line-height:
normal" class="MsoNormal"><b><span style="font-size:12.0pt;font-family:Calibri-Bold;mso-bidi-font-family:
Calibri-Bold">Simulator Service</span></b><span style="font-size:12.0pt;
font-family:"Times New Roman",serif;mso-fareast-font-family:"Times New Roman";
color:#323333"></span></p>
</td>
<td style="width: 116.85pt; border-top: 1pt solid windowtext; border-right: 1pt solid windowtext; border-bottom: 1pt solid windowtext; padding: 0in 5.4pt; height: 30.1pt;" valign="top" width="346">
<p style="margin-bottom:0in;margin-bottom:.0001pt;
text-align:center;line-height:normal" align="center" class="MsoNormal"><b><span style="font-size:12.0pt;
font-family:Calibri-Bold;mso-bidi-font-family:Calibri-Bold">DNS</span></b><span style="font-size:12.0pt;font-family:"Times New Roman",serif;mso-fareast-font-family:
"Times New Roman";color:#323333"></span></p>
</td>
<td style="width: 116.9pt; border-top: 1pt solid windowtext; border-right: 1pt solid windowtext; border-bottom: 1pt solid windowtext; padding: 0in 5.4pt; height: 30.1pt;" valign="top" width="119">
<p style="margin-bottom:0in;margin-bottom:.0001pt;
text-align:center;line-height:normal" align="center" class="MsoNormal"><b><span style="font-size:12.0pt;
font-family:Calibri-Bold;mso-bidi-font-family:Calibri-Bold">Protocol</span></b><span style="font-size:12.0pt;font-family:"Times New Roman",serif;mso-fareast-font-family:
"Times New Roman";color:#323333"></span></p>
</td>
<td style="width: 116.9pt; border-top: 1pt solid windowtext; border-right: 1pt solid windowtext; border-bottom: 1pt solid windowtext; padding: 0in 5.4pt; height: 30.1pt;" valign="top" width="119">
<p style="margin-bottom:0in;margin-bottom:.0001pt;
text-align:center;line-height:normal" align="center" class="MsoNormal"><b><span style="font-size:12.0pt;
font-family:Calibri-Bold;mso-bidi-font-family:Calibri-Bold">TCP Port</span></b><span style="font-size:12.0pt;font-family:"Times New Roman",serif;mso-fareast-font-family:
"Times New Roman";color:#323333"></span></p>
</td>
</tr>
<tr>
<td style="width: 116.85pt; border-right: 1pt solid windowtext; border-bottom: 1pt solid windowtext; border-left: 1pt solid windowtext; padding: 0in 5.4pt;" valign="top" width="123">
<p style="margin-bottom:0in;margin-bottom:.0001pt;line-height:
normal;mso-layout-grid-align:none;text-autospace:none" class="MsoNormal"><span style="font-size:8.0pt;mso-bidi-font-size:9.0pt;font-family:"Courier New"">Intuitive</span></p>
<p style="margin-bottom:0in;margin-bottom:.0001pt;line-height:
normal" class="MsoNormal"><span style="font-size:8.0pt;mso-bidi-font-size:9.0pt;font-family:
"Courier New"">Surgical Data</span><span style="font-size:8.0pt;mso-bidi-font-size:
12.0pt;font-family:"Times New Roman",serif;mso-fareast-font-family:"Times New Roman";
color:#323333"></span></p>
</td>
<td style="width: 116.85pt; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; padding: 0in 5.4pt;" valign="top" width="346">
<p style="margin-bottom:0in;margin-bottom:.0001pt;line-height:
normal" class="MsoNormal"><span style="font-size:9.0pt;font-family:"Courier New"">TRN3566D.isrg-simulation.com</span><span style="font-size:12.0pt;font-family:"Times New Roman",serif;mso-fareast-font-family:
"Times New Roman";color:#323333"></span></p>
</td>
<td style="width: 116.9pt; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; padding: 0in 5.4pt;" valign="top" width="119">
<p style="margin-bottom:0in;margin-bottom:.0001pt;line-height:
normal" class="MsoNormal"><span style="font-size:9.0pt;font-family:"Courier New"">TLS 1.2</span></p>
</td>
<td style="width: 116.9pt; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; padding: 0in 5.4pt;" valign="top" width="119">
<p style="margin-bottom:0in;margin-bottom:.0001pt;line-height:
normal;mso-layout-grid-align:none;text-autospace:none" class="MsoNormal"><span style="font-size:9.0pt;font-family:"Courier New"">443</span></p>
<p style="margin-bottom:0in;margin-bottom:.0001pt;line-height:
normal;mso-layout-grid-align:none;text-autospace:none" class="MsoNormal"><span style="font-size:9.0pt;font-family:"Courier New"">(outbound</span></p>
<p style="margin-bottom:0in;margin-bottom:.0001pt;line-height:
normal" class="MsoNormal"><span style="font-size:9.0pt;font-family:"Courier New"">only)</span><span style="font-size:12.0pt;font-family:"Times New Roman",serif;mso-fareast-font-family:
"Times New Roman";color:#323333"></span></p>
</td>
</tr>
<tr>
<td style="width: 116.85pt; border-right: 1pt solid windowtext; border-bottom: 1pt solid windowtext; border-left: 1pt solid windowtext; padding: 0in 5.4pt;" valign="top" width="123">
<p style="margin-bottom:0in;margin-bottom:.0001pt;line-height:
normal;mso-layout-grid-align:none;text-autospace:none" class="MsoNormal"><span style="font-size:8.0pt;mso-bidi-font-size:9.0pt;font-family:"Courier New"">Intuitive</span></p>
<p style="margin-bottom:0in;margin-bottom:.0001pt;line-height:
normal" class="MsoNormal"><span style="font-size:8.0pt;mso-bidi-font-size:9.0pt;font-family:
"Courier New"">Surgical Data</span><span style="font-size:8.0pt;mso-bidi-font-size:
12.0pt;font-family:"Times New Roman",serif;mso-fareast-font-family:"Times New Roman";
color:#323333"></span></p>
</td>
<td style="width: 116.85pt; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; padding: 0in 5.4pt;" valign="top" width="346">
<p style="margin-bottom:0in;margin-bottom:.0001pt;line-height:
normal" class="MsoNormal"><span style="font-size:9.0pt;font-family:"Courier New"">TRN29DF9.isrg-simulation.com</span><span style="font-size:12.0pt;font-family:"Times New Roman",serif;mso-fareast-font-family:
"Times New Roman";color:#323333"></span></p>
</td>
<td style="width: 116.9pt; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; padding: 0in 5.4pt;" valign="top" width="119">
<p style="margin-bottom:0in;margin-bottom:.0001pt;line-height:
normal" class="MsoNormal"><span style="font-size:9.0pt;font-family:"Courier New"">TLS 1.2</span></p>
</td>
<td style="width: 116.9pt; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; padding: 0in 5.4pt;" valign="top" width="119">
<p style="margin-bottom:0in;margin-bottom:.0001pt;line-height:
normal;mso-layout-grid-align:none;text-autospace:none" class="MsoNormal"><span style="font-size:9.0pt;font-family:"Courier New"">443</span></p>
<p style="margin-bottom:0in;margin-bottom:.0001pt;line-height:
normal;mso-layout-grid-align:none;text-autospace:none" class="MsoNormal"><span style="font-size:9.0pt;font-family:"Courier New"">(outbound</span></p>
<p style="margin-bottom:0in;margin-bottom:.0001pt;line-height:
normal" class="MsoNormal"><span style="font-size:9.0pt;font-family:"Courier New"">only)</span><span style="font-size:12.0pt;font-family:"Times New Roman",serif;mso-fareast-font-family:
"Times New Roman";color:#323333"></span></p>
</td>
</tr>
<tr>
<td style="width: 116.85pt; border-right: 1pt solid windowtext; border-bottom: 1pt solid windowtext; border-left: 1pt solid windowtext; padding: 0in 5.4pt;" valign="top" width="123">
<p style="margin-bottom:0in;margin-bottom:.0001pt;line-height:
normal" class="MsoNormal"><span style="font-size:8.0pt;mso-bidi-font-size:12.0pt;font-family:
"Times New Roman",serif;mso-fareast-font-family:"Times New Roman";color:#323333"> </span></p>
</td>
<td style="width: 116.85pt; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; padding: 0in 5.4pt;" valign="top" width="346">
<p style="margin-bottom:0in;margin-bottom:.0001pt;line-height:
normal" class="MsoNormal"><span style="font-size:9.0pt;font-family:"Courier New"">TRN7AF33.isrg-simulation.com</span><span style="font-size:12.0pt;font-family:"Times New Roman",serif;mso-fareast-font-family:
"Times New Roman";color:#323333"></span></p>
</td>
<td style="width: 116.9pt; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; padding: 0in 5.4pt;" valign="top" width="119">
<p style="margin-bottom:0in;margin-bottom:.0001pt;line-height:
normal" class="MsoNormal"><span style="font-size:9.0pt;font-family:"Courier New"">TLS 1.2</span></p>
</td>
<td style="width: 116.9pt; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; padding: 0in 5.4pt;" valign="top" width="119">
<p style="margin-bottom:0in;margin-bottom:.0001pt;line-height:
normal;mso-layout-grid-align:none;text-autospace:none" class="MsoNormal"><span style="font-size:9.0pt;font-family:"Courier New"">443</span></p>
<p style="margin-bottom:0in;margin-bottom:.0001pt;line-height:
normal;mso-layout-grid-align:none;text-autospace:none" class="MsoNormal"><span style="font-size:9.0pt;font-family:"Courier New"">(outbound</span></p>
<p style="margin-bottom:0in;margin-bottom:.0001pt;line-height:
normal" class="MsoNormal"><span style="font-size:9.0pt;font-family:"Courier New"">only)</span><span style="font-size:12.0pt;font-family:"Times New Roman",serif;mso-fareast-font-family:
"Times New Roman";color:#323333"></span></p>
</td>
</tr>
<tr>
<td style="width: 116.85pt; border-right: 1pt solid windowtext; border-bottom: 1pt solid windowtext; border-left: 1pt solid windowtext; padding: 0in 5.4pt;" valign="top" width="123">
<p style="margin-bottom:0in;margin-bottom:.0001pt;line-height:
normal" class="MsoNormal"><span style="font-size:8.0pt;mso-bidi-font-size:12.0pt;font-family:
"Times New Roman",serif;mso-fareast-font-family:"Times New Roman";color:#323333"> </span></p>
</td>
<td style="width: 116.85pt; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; padding: 0in 5.4pt;" valign="top" width="346">
<p style="margin-bottom:0in;margin-bottom:.0001pt;line-height:
normal" class="MsoNormal"><span style="font-size:9.0pt;font-family:"Courier New"">bbffa27760964baaaa18d9ea.blob.core.windows.net</span><span style="font-size:12.0pt;font-family:"Times New Roman",serif;mso-fareast-font-family:
"Times New Roman";color:#323333"></span></p>
</td>
<td style="width: 116.9pt; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; padding: 0in 5.4pt;" valign="top" width="119">
<p style="margin-bottom:0in;margin-bottom:.0001pt;line-height:
normal" class="MsoNormal"><span style="font-size:9.0pt;font-family:"Courier New"">TLS 1.2</span></p>
</td>
<td style="width: 116.9pt; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; padding: 0in 5.4pt;" valign="top" width="119">
<p style="margin-bottom:0in;margin-bottom:.0001pt;line-height:
normal;mso-layout-grid-align:none;text-autospace:none" class="MsoNormal"><span style="font-size:9.0pt;font-family:"Courier New"">443</span></p>
<p style="margin-bottom:0in;margin-bottom:.0001pt;line-height:
normal;mso-layout-grid-align:none;text-autospace:none" class="MsoNormal"><span style="font-size:9.0pt;font-family:"Courier New"">(outbound</span></p>
<p style="margin-bottom:0in;margin-bottom:.0001pt;line-height:
normal;mso-layout-grid-align:none;text-autospace:none" class="MsoNormal"><span style="font-size:9.0pt;font-family:"Courier New"">only) 443</span></p>
<p style="margin-bottom:0in;margin-bottom:.0001pt;line-height:
normal;mso-layout-grid-align:none;text-autospace:none" class="MsoNormal"><span style="font-size:9.0pt;font-family:"Courier New"">(outbound</span></p>
<p style="margin-bottom:0in;margin-bottom:.0001pt;line-height:
normal" class="MsoNormal"><span style="font-size:9.0pt;font-family:"Courier New"">only)</span><span style="font-size:12.0pt;font-family:"Times New Roman",serif;mso-fareast-font-family:
"Times New Roman";color:#323333"></span></p>
</td>
</tr>
<tr>
<td style="width: 116.85pt; border-right: 1pt solid windowtext; border-bottom: 1pt solid windowtext; border-left: 1pt solid windowtext; padding: 0in 5.4pt;" valign="top" width="123">
<p style="margin-bottom:0in;margin-bottom:.0001pt;line-height:
normal" class="MsoNormal"><span style="font-size:8.0pt;mso-bidi-font-size:12.0pt;font-family:
"Times New Roman",serif;mso-fareast-font-family:"Times New Roman";color:#323333"> </span></p>
</td>
<td style="width: 116.85pt; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; padding: 0in 5.4pt;" valign="top" width="346">
<p style="margin-bottom:0in;margin-bottom:.0001pt;line-height:
normal" class="MsoNormal"><span style="font-size:9.0pt;font-family:"Courier New"">TRN087D7.isrg-simulation.com</span><span style="font-size:12.0pt;font-family:"Times New Roman",serif;mso-fareast-font-family:
"Times New Roman";color:#323333"></span></p>
</td>
<td style="width: 116.9pt; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; padding: 0in 5.4pt;" valign="top" width="119">
<p style="margin-bottom:0in;margin-bottom:.0001pt;line-height:
normal" class="MsoNormal"><span style="font-family: "Courier New"; font-size: 12px;">TLS 1.2</span></p>
</td>
<td style="width: 116.9pt; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; padding: 0in 5.4pt;" valign="top" width="119">
<p style="margin-bottom:0in;margin-bottom:.0001pt;line-height:
normal;mso-layout-grid-align:none;text-autospace:none" class="MsoNormal"><span style="font-size:9.0pt;font-family:"Courier New"">443</span></p>
<p style="margin-bottom:0in;margin-bottom:.0001pt;line-height:
normal;mso-layout-grid-align:none;text-autospace:none" class="MsoNormal"><span style="font-size:9.0pt;font-family:"Courier New"">(outbound</span></p>
<p style="margin-bottom:0in;margin-bottom:.0001pt;line-height:
normal" class="MsoNormal"><span style="font-size:9.0pt;font-family:"Courier New"">only)</span><span style="font-size:12.0pt;font-family:"Times New Roman",serif;mso-fareast-font-family:
"Times New Roman";color:#323333"></span></p>
</td>
</tr>
<tr>
<td style="width: 116.85pt; border-right: 1pt solid windowtext; border-bottom: 1pt solid windowtext; border-left: 1pt solid windowtext; padding: 0in 5.4pt;" valign="top" width="123">
<p style="margin-bottom:0in;margin-bottom:.0001pt;line-height:
normal;mso-layout-grid-align:none;text-autospace:none" class="MsoNormal"><span style="font-size:8.0pt;mso-bidi-font-size:9.0pt;font-family:"Courier New"">Intuitive</span></p>
<p style="margin-bottom:0in;margin-bottom:.0001pt;line-height:
normal;mso-layout-grid-align:none;text-autospace:none" class="MsoNormal"><span style="font-size:8.0pt;mso-bidi-font-size:9.0pt;font-family:"Courier New"">Surgical PKI</span></p>
<p style="margin-bottom:0in;margin-bottom:.0001pt;line-height:
normal" class="MsoNormal"><span style="font-size:8.0pt;mso-bidi-font-size:9.0pt;font-family:
"Courier New"">Management System</span><span style="font-size:8.0pt;
mso-bidi-font-size:12.0pt;font-family:"Times New Roman",serif;mso-fareast-font-family:
"Times New Roman";color:#323333"></span></p>
</td>
<td style="width: 116.85pt; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; padding: 0in 5.4pt;" valign="top" width="346">
<p style="margin-bottom:0in;margin-bottom:.0001pt;line-height:
normal" class="MsoNormal"><span style="font-size:9.0pt;font-family:"Courier New"">crl.isrg-simulation.com (ISI PKI)</span><span style="font-size:12.0pt;font-family:"Times New Roman",serif;
mso-fareast-font-family:"Times New Roman";color:#323333"></span></p>
</td>
<td style="width: 116.9pt; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; padding: 0in 5.4pt;" valign="top" width="119">
<p style="margin-bottom:0in;margin-bottom:.0001pt;line-height:
normal" class="MsoNormal">
<font face="Times New Roman, serif" color="#323333">certificate</font>
</p>
<p style="margin-bottom:0in;margin-bottom:.0001pt;line-height:
normal" class="MsoNormal">
<font face="Times New Roman, serif" color="#323333">revocation list</font>
</p>
</td>
<td style="width: 116.9pt; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; padding: 0in 5.4pt;" valign="top" width="119">
<p style="margin-bottom:0in;margin-bottom:.0001pt;line-height:
normal;mso-layout-grid-align:none;text-autospace:none" class="MsoNormal"><span style="font-size:9.0pt;font-family:"Courier New"">80 (outbound</span></p>
<p style="margin-bottom:0in;margin-bottom:.0001pt;line-height:
normal" class="MsoNormal"><span style="font-size:9.0pt;font-family:"Courier New"">only)</span><span style="font-size:12.0pt;font-family:"Times New Roman",serif;mso-fareast-font-family:
"Times New Roman";color:#323333"></span></p>
</td>
</tr>
</tbody>
</table>
</div>
</div>
</fieldset>
<fieldset id="tfa_Firewall" class="section">
<legend id="tfa_Firewall-L"><b>Wired Specifications: </b> <i>Note: Wireless configuration options available upon request.</i></legend>
<div id="tfa_7785203260773" class="section inline group">
<div class="oneField field-container-D " id="tfa_7785203260767-D" role="group" aria-labelledby="tfa_7785203260767-L" data-tfa-labelledby="-L tfa_7785203260767-L">
<label id="tfa_7785203260767-L" class="label preField ">
<p><b>Please specify how the IP address will be provided to the <i>da Vinci Skills Simulator </i>(DHCP or Static)? </b></p>
<p><span style="color: rgb(50, 51, 51); font-family: "Times New Roman", serif; font-size: 16px;"> </span></p>
</label><br>
<div class="inputWrapper"><span id="tfa_7785203260767" class="choices vertical "><span class="oneChoice"><input type="checkbox" value="tfa_7785203260768" class="" id="tfa_7785203260768" name="tfa_7785203260768"
aria-labelledby="tfa_7785203260768-L" data-tfa-labelledby="tfa_7785203260767-L tfa_7785203260768-L"><label class="label postField" id="tfa_7785203260768-L" for="tfa_7785203260768"><span
class="input-checkbox-faux"></span>DHCP</label></span><span class="oneChoice"><input type="checkbox" value="tfa_7785203260769" class="" id="tfa_7785203260769" name="tfa_7785203260769" aria-labelledby="tfa_7785203260769-L"
data-tfa-labelledby="tfa_7785203260767-L tfa_7785203260769-L"><label class="label postField" id="tfa_7785203260769-L" for="tfa_7785203260769"><span class="input-checkbox-faux"></span>Reserved DHCP</label></span><span
class="oneChoice"><input type="checkbox" value="tfa_7785203260770" class="" id="tfa_7785203260770" name="tfa_7785203260770" aria-labelledby="tfa_7785203260770-L" data-tfa-labelledby="tfa_7785203260767-L tfa_7785203260770-L"><label
class="label postField" id="tfa_7785203260770-L" for="tfa_7785203260770"><span class="input-checkbox-faux"></span>Static</label></span></span></div>
</div>
</div>
<div class="htmlSection" id="tfa_7785203260750">
<div class="htmlContent" id="tfa_7785203260750-HTML">
<p><br></p>
<p><span style="background-color: transparent; font-family: serif; word-spacing: normal;"><b>If static IP is preferred, please fill in the following information below:</b></span></p>
</div>
</div>
<div class="oneField field-container-D " id="tfa_7785203260766-D">
<label id="tfa_7785203260766-L" class="label preField " for="tfa_7785203260766">IP Address</label><br>
<div class="inputWrapper"><input type="text" id="tfa_7785203260766" name="tfa_7785203260766" value="" title="IP Address" class=""></div>
</div>
<div class="oneField field-container-D " id="tfa_SubnetMask1-D">
<label id="tfa_SubnetMask1-L" class="label preField " for="tfa_SubnetMask1">Subnet Mask</label><br>
<div class="inputWrapper"><input type="text" id="tfa_SubnetMask1" name="tfa_SubnetMask1" value="" title="Subnet Mask" class=""></div>
</div>
<div class="oneField field-container-D " id="tfa_DefaultGateway1-D">
<label id="tfa_DefaultGateway1-L" class="label preField " for="tfa_DefaultGateway1">Default Gateway</label><br>
<div class="inputWrapper"><input type="text" id="tfa_DefaultGateway1" name="tfa_DefaultGateway1" value="" title="Default Gateway" class=""></div>
</div>
<div class="oneField field-container-D " id="tfa_DNSPrimary1-D">
<label id="tfa_DNSPrimary1-L" class="label preField " for="tfa_DNSPrimary1">DNS Primary</label><br>
<div class="inputWrapper"><input type="text" id="tfa_DNSPrimary1" name="tfa_DNSPrimary1" value="" title="DNS Primary" class=""></div>
</div>
<div class="oneField field-container-D " id="tfa_7785203260772-D">
<label id="tfa_7785203260772-L" class="label preField " for="tfa_7785203260772">DNS Primary</label><br>
<div class="inputWrapper"><input type="text" id="tfa_7785203260772" name="tfa_7785203260772" value="" title="DNS Primary" class=""></div>
</div>
<div class="oneField field-container-D " id="tfa_DNSSecondary1-D">
<label id="tfa_DNSSecondary1-L" class="label preField " for="tfa_DNSSecondary1">DNS Secondary</label><br>
<div class="inputWrapper"><input type="text" id="tfa_DNSSecondary1" name="tfa_DNSSecondary1" value="" title="DNS Secondary" class=""></div>
</div>
<div class="htmlSection" id="tfa_7785203260752">
<div class="htmlContent" id="tfa_7785203260752-HTML">
<p style="text-align: left;"><br></p>
<p></p>
<p style="text-align: left;"><label class="label preField" id="tfa_Hastheassignedda-L"><b>Has the assigned network data port confirmed to be active and properly configured?</b></label></p>
</div>
</div>
<div id="tfa_7785203260776" class="section inline group">
<div class="oneField field-container-D " id="tfa_7785203260774-D">
<label id="tfa_7785203260774-L" class="label preField " for="tfa_7785203260774">Yes</label><br>
<div class="inputWrapper"><input type="text" id="tfa_7785203260774" name="tfa_7785203260774" value="" title="Yes" class=""></div>
</div>
<div class="oneField field-container-D " id="tfa_7785203260775-D">
<label id="tfa_7785203260775-L" class="label preField " for="tfa_7785203260775">No</label><br>
<div class="inputWrapper"><input type="text" id="tfa_7785203260775" name="tfa_7785203260775" value="" title="No" class=""></div>
</div>
</div>
<fieldset id="tfa_7785203260778" class="section">
<legend id="tfa_7785203260778-L">Data Jack Location</legend>
<div id="tfa_7785203260781" class="section inline group">
<div class="oneField field-container-D " id="tfa_7785203260779-D">
<label id="tfa_7785203260779-L" class="label preField " for="tfa_7785203260779">OR</label><br>
<div class="inputWrapper"><input type="text" id="tfa_7785203260779" name="tfa_7785203260779" value="" title="OR" class=""></div>
</div>
<div class="oneField field-container-D " id="tfa_7785203260780-D">
<label id="tfa_7785203260780-L" class="label preField " for="tfa_7785203260780">Data Port</label><br>
<div class="inputWrapper"><input type="text" id="tfa_7785203260780" name="tfa_7785203260780" value="" title="Data Port" class=""></div>
</div>
<div class="oneField field-container-D " id="tfa_7785203260782-D">
<label id="tfa_7785203260782-L" class="label preField " for="tfa_7785203260782">Jack No.</label><br>
<div class="inputWrapper"><input type="text" id="tfa_7785203260782" name="tfa_7785203260782" value="" title="Jack No." class=""></div>
</div>
</div>
</fieldset>
</fieldset>
<fieldset id="tfa_6088437796645" class="section">
<legend id="tfa_6088437796645-L">Submit</legend>
<div class="htmlSection" id="tfa_7785203260757">
<div class="htmlContent" id="tfa_7785203260757-HTML">
<p>By clicking “submit,” this Hospital/Organization warrants that the information provided above is accurate and grants permission to Intuitive Surgical to attach its <em>Skills Simulator(s)</em> to its network as structured above for
its intended purposes. Given that the Hospital/Organization owns and manages its network infrastructure and configuration, Intuitive Surgical cannot be, and is not responsible for any network changes, disturbances, interruptions of
service or suboptimal performance that may result from changes out of Intuitive Surgical’s control.</p>
<p><span style="font-size: x-small;"><sup>1</sup><em>da Vinci<sub>®</sub></em> Skills Simulator<em><sup>™</sup></em> shall mean any <em>da Vinci</em> Skills Simulator (past, present, or future models) you have obtained or purchased or will
obtain or purchase from Intuitive Surgical, whether via upgrade, purchase, trade-ins, swap-outs, or otherwise. References in this survey or related document to <em>Skills Simulator</em> or <em>Simulator</em> shall be deemed to refer
to the <em>Skills Simulator</em> for the <em>da Vinci</em> Surgical System as defined here.</span></p>
<p> </p>
<p><span style="font-size: x-small;">Intuitive Surgical and its affiliates within the Intuitive Surgical group of companies (collectively, “Intuitive”) may collect data relating to your use of Intuitive products (“Data”). In some
instances Data may be communicated via data gathering or transmission technology to Intuitive. In other instances, Intuitive may require you to provide Data to Intuitive. Such Data may be used for a variety of purposes,
including, but not limited to (1) providing support and preventative maintenance of Intuitive products, (2) improving Intuitive products or services, (3) ensuring compliance with applicable laws and regulations, and (4) providing a
general resource for Intuitive’s research and business development. Intuitive does not intend to collect protected health information (PHI) as defined by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) or
analogous foreign patient privacy laws or regulations, as may be amended from time to time. In the event any Data communicated to Intuitive identifies an entity or individual, Intuitive will not share such Data with any third
parties without the entity’s or individual’s consent, unless required by law or regulatory authorities.</span></p>
<p> </p>
</div>
</div>
<input type="hidden" id="tfa_Customerhasagree" name="tfa_Customerhasagree" value="" class="">
</fieldset>
<div class="actions" id="4884070-A"><input type="submit" data-label="submit" class="primaryAction" id="submit_button" value="submit"></div>
<div style="clear:both"></div>
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id="tfa_dbWorkflowSessionUuid"><input type="hidden" value="1649254226" name="tfa_dbTimeStarted" id="tfa_dbTimeStarted" autocomplete="off"><input type="hidden" value="22" name="tfa_dbVersionId" id="tfa_dbVersionId"><input type="hidden"
value="saveAndResumeFieldset" name="tfa_switchedoff" id="tfa_switchedoff">
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<div class="oneField">
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</form>Text Content
DA VINCI SIMNOW SIMULATOR NETWORK SURVEY Save my progress and resume later | Resume a previously saved form Resume Later In order to be able to resume this form later, please enter your email and choose a password. Your Email: A Password: Confirm Password: Survey Overview This site survey questionnaire is used to request network information to configure your SimNow Skills Simulator™1for the da Vinci® Surgical System. The requested network information that you provide will be used by Intuitive Surgical personnel to configure the SimNow Skills Simulator for use on the network. For any questions regarding this survey please contact the Intuitive Surgical Product Networking and Data Team at 1(800) 876-1310 opt 2,2 or email PND@intusurg.com. Hospital / System Information Hospital / Organization: Customer / Contact: Title: Phone #: Contact eMail: Address 1: Address 2: City: Zip/Postal Code: Country: Please select... Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia Botswana Bouvet Island Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos ( Keeling ) Islands Colombia Comoros Congo Cook Islands Costa Rica Côte d ' Ivoire Croatia ( Hrvatska ) Cuba Cyprus Czech Republic Congo ( DRC ) Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Faroe Islands Fiji Islands Finland France French Guiana French Polynesia Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong SAR Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao SAR Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Samoa San Marino São Tomé and Prìncipe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa S Georgia & S Sandwich Islands Spain Sri Lanka St. Helena St. Kitts and Nevis St. Lucia St. Pierre and Miquelon St. Vincent and the Grenadines Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Viet Nam Virgin Islands Wallis and Futuna Yemen Zambia Zimbabwe ID Number(s) or TRK ID(s) (Can be located on the label on the back side of the Skills Simulator, starting with P177...) Skills Simulator Location: Message: IT Contacts Please fill out IT contact information. The primary IT contact will be considered by Intuitive Surgical to be the customer's network point of contact. IT Primary Contact IT Primary Contact Name: IT Primary Contact email: IT Primary Contact Phone: IT Primary Contact Mobile: IT Secondary Contact IT Secondary Contact Name: IT Secondary Contact email: IT Secondary Contact Phone: IT Secondary Contact Mobile: SimNow Firewall Requirements The da Vinci SimNow Skills Simulator requires access to the following URLs on the Internet. The da Vinci Skills Simulator negotiates an outgoing SSL (TLS) session based on PKI certificate authentication with the Intuitive Surgical cloud server infrastructure to enable simulation content updates, system compatibility firmware updates, operating system patches, anti-virus definition updates, simulator use metrics, and simulator configurations. The simulator does not store, nor has access to any protected health information. Simulator Service DNS Protocol TCP Port Intuitive Surgical Data TRN3566D.isrg-simulation.com TLS 1.2 443 (outbound only) Intuitive Surgical Data TRN29DF9.isrg-simulation.com TLS 1.2 443 (outbound only) TRN7AF33.isrg-simulation.com TLS 1.2 443 (outbound only) bbffa27760964baaaa18d9ea.blob.core.windows.net TLS 1.2 443 (outbound only) 443 (outbound only) TRN087D7.isrg-simulation.com TLS 1.2 443 (outbound only) Intuitive Surgical PKI Management System crl.isrg-simulation.com (ISI PKI) certificate revocation list 80 (outbound only) Wired Specifications: Note: Wireless configuration options available upon request. Please specify how the IP address will be provided to the da Vinci Skills Simulator (DHCP or Static)? DHCPReserved DHCPStatic If static IP is preferred, please fill in the following information below: IP Address Subnet Mask Default Gateway DNS Primary DNS Primary DNS Secondary Has the assigned network data port confirmed to be active and properly configured? Yes No Data Jack Location OR Data Port Jack No. Submit By clicking “submit,” this Hospital/Organization warrants that the information provided above is accurate and grants permission to Intuitive Surgical to attach its Skills Simulator(s) to its network as structured above for its intended purposes. Given that the Hospital/Organization owns and manages its network infrastructure and configuration, Intuitive Surgical cannot be, and is not responsible for any network changes, disturbances, interruptions of service or suboptimal performance that may result from changes out of Intuitive Surgical’s control. 1da Vinci® Skills Simulator™ shall mean any da Vinci Skills Simulator (past, present, or future models) you have obtained or purchased or will obtain or purchase from Intuitive Surgical, whether via upgrade, purchase, trade-ins, swap-outs, or otherwise. References in this survey or related document to Skills Simulator or Simulator shall be deemed to refer to the Skills Simulator for the da Vinci Surgical System as defined here. Intuitive Surgical and its affiliates within the Intuitive Surgical group of companies (collectively, “Intuitive”) may collect data relating to your use of Intuitive products (“Data”). In some instances Data may be communicated via data gathering or transmission technology to Intuitive. In other instances, Intuitive may require you to provide Data to Intuitive. Such Data may be used for a variety of purposes, including, but not limited to (1) providing support and preventative maintenance of Intuitive products, (2) improving Intuitive products or services, (3) ensuring compliance with applicable laws and regulations, and (4) providing a general resource for Intuitive’s research and business development. Intuitive does not intend to collect protected health information (PHI) as defined by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) or analogous foreign patient privacy laws or regulations, as may be amended from time to time. In the event any Data communicated to Intuitive identifies an entity or individual, Intuitive will not share such Data with any third parties without the entity’s or individual’s consent, unless required by law or regulatory authorities. Save my progress and resume later | Resume a previously saved form Contact Information